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ONE ON ONE WITH DR. WAFULA NALWA, THE CARDIOLOGIST

What is leukemia?

I still remember the first time I heard about Leukemia. I had probably heard it before, but the first time I heard the word and took a moment to internalize it was in my 2nd year of high school. I was reading Margarete Ogola’s The River and The Source when I came across the word for the very first time. One of the grand children of the legendary Akoko had leukemia. In the story, one of the characters asks why such a young child would have cancer and the response was that it was a blood cancer and that particular type could affect even children. Basically, in simple terms, that is what leukemia is.

As defined in the introductory article to this segment, cancer is uncontrolled cell growth. Blood, like any other tissue in the body is made up of cells. And like other cells in the body, blood cells can divide uncontrollably and result in cancer of that particular line of cells. There are three basic blood cell lines: red blood cells, white blood cells and platelets. Blood cells, and therefore blood, are mainly made in the bone marrow. It is in the bone marrow where the “mothers” of blood cells reside. These are also known as stem cells. Just like in the river and the source, the genetic makeup of the mother is passed down to subsequent generations. Therefore, a default in the mother cell (also known as a mutation) is passed down to its daughter cells. The appearance of a faulty blood cell in the circulating blood hence suggests a problem at the source.

Leukemia literally means an excess of white blood cells. These cells however, because of uncontrolled multiplication, are immature and therefore cannot carry out the function of normal white blood cells resulting in symptoms and signs. Broadly speaking, leukemia can be classified as either acute or chronic: the details are however beyond the scope of this article.

Who can get Leukemia?

Cancer of the blood can affect anyone regardless of age, gender or ethnicity. It has however, statistically, been shown to affect males more than females and there are age brackets within which leukemia seems to be more prevalent. The acute form tends to mainly affect children between the ages of 1 and 7 while the chronic form affects older generations more.

Like most other cancers, it is difficult to predict who would and who wouldn’t get leukemia. However, there are a number of genetic and environmental factors that have been shown to predispose one to development of leukemia. These include, but are not limited to: family history of leukemia or other cancers, having had chemotherapy for treatment of cancer or other illnesses or ironizing radiation either for therapeutic purposes or accidental industrial exposures. Other risk factors include immunosuppression as in HIV and other viruses and people living with downs syndrome.

It is not to say that all people having the above factors will develop leukemia. These are only risk factors and the question of who gets and who does not have a definite answer. There are patients who are diagnosed with leukemia without any predisposing risks and there are people who live a lifetime with two or even more of the risk factors and do not develop the deadly illness.

 What are the signs and symptoms of Leukemia?

As explained, leukemia affects blood cells and therefore the signs and symptoms will mainly be related to the affected body   organ, in this case, blood. The various blood cells all have different functions in our bodies. White blood cells, for example, and which are mostly affected in leukemia, are responsible fighting infections. When their production is affected (both quality and quantity) as in leukemia, the bodies defense mechanism against infections goes down and the patients surfer recurrent infections that would otherwise be fought off by the body without any symptoms. Other sighs of reduced immunity are poor healing of wounds and unexplained fevers.

Red blood cells on the other hand are charged with the transportation of oxygen which is required for all body functions. Impaired production of red blood cells results in anemia which in itself if not corrected early can be life threatening.

The third line of blood cells are platelets. These are important when it comes to blood clotting and a low platelet count results in easy bleeding and reduced ability of the blood to clot when an injury is sustained. In a nutshell, these are the main effects of leukemia. However, there are several other signs and symptoms of leukemia including: weight loss, sweating at night loss of appetite etc. Swelling of lymph nodes is also a common sign.

bleeding under the skin a sign of low platelet count may indicate leukemia

It is however very important to note that most of these physical signs and symptoms of leukemia, like other cancers manifest when the disease is already in advanced stages. Ideally, and in some countries with advanced medical technology, occasional blood screens are done and with these, it is possible to catch these early enough.

How to screen for Leukemia.

The best way to screen for leukemia is to do blood tests. Immature cells growing and multiplying in the bone marrow spill into the circulating blood and can be seen with simple blood tests. A complete blood count may identify an elevated or reduced white cell count. Anemia and low platelet count can also be caught before any symptoms.

A peripheral blood smear is prepared with a drop of blood and blood cells observed under a microscope by a doctor. It is possible, even in the very early stages to identify immature cells and even make a definitive diagnosis of leukemia. Abnormalities identified on a complete blood count and blood smear can be confirmed by taking a biopsy for histological examination of either the bone marrow or a swollen lymph node.

Is Leukemia Treatable?

There are many types of leukemia and all of them have different protocol for treatment. The cancer if fatal and progresses very fast. However, the silver lining is that most leukemia responds fairly well to treatment. If suspected or once the diagnosis is made, it is important for the patient see to an oncologist or physician for definitive management; including chemotherapy, radiotherapy and bone marrow transplantation.

It is also important to accompany the definitive treatment with supportive management. This means, in simple terms, treating accompanying symptoms and illnesses accordingly. These include, blood transfusions, pain medication and antibiotics for infections. The importance of palliation cannot be overlooked in leukemia that is too advanced or one that has failed to respond to treatment.

Leukemia in children

Acute lymphoblastic leukemia (a subtype of leukemia) is statistically the most common childhood cancer in the world. Signs and symptoms like the rest of the population occur late and parents and guardians should seek medical attention as soon as possible if any of the aforementioned are noticed. It is also important to carry out screening especially in children with any of the risk factors described in this article. Screening is quick, affordable and can be life saving if an abnormality were to be detected.

This is purely an informative article and is not meant to replace your doctor. Seek medical advice and avoid over the counter prescriptions.

By Dr. Nyadimu

Nyadimu Festo MD

Medical Doctor. MBChB with IT (Maseno university). Passionate about medicine, writing and leadership. Voice of the Kenyan doctor.

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